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Year 3 - Medicine Block 1 > Resp - Lung Cancer > Flashcards

Flashcards in Resp - Lung Cancer Deck (11)
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1
Q

name possible risk factors for lung cancer

A
  1. smoking (active or passive)
  2. increasing age (60-80 yrs)
  3. occupational exposure to asbestos or silicon
  4. exposure to radon or air pollution
  5. family Hx
  6. COPD or TB
  7. chest radiotherapy
2
Q

describe the main types of lung cancer. which is most common?

A
  1. Non-small cell carcinoma (85%)
    i) Squamous cell carcinoma
    • local spread common (often present as obstructive lesions of bronchus causing infection) but widespread metastasis relatively late
      ii) Adenocarcinomas
    • arise from mucous cells
    • invasion of pleura and mediastinal LNs common, often metastasise to brain and bone
      iii) Large cell carcinomas
    • less differentiated form of above
    • metastasise early
      iv) Carcinoid tumours
      v) Bronchoalveolar cell carcinoma
  2. Small cell carcinoma (15%)
    - arise from Kultchitsky/enterochromaffin cells (endocrine cells that manufacture polypeptides and amines which act as hormones or NTs)
    - rapid growth and highly malignant, spread early and almost always inoperable at presentation
3
Q

which type of lung cancer is more common in non-smokers? in asbestos exposure?

A

adenocarcinoma

4
Q

what symptoms can be caused by a primary tumour?

A

Often asymptomatic but can have:

  • persistent cough or change in nature of cough (e.g. bovine)
  • dyspnoea
  • haemoptysis
  • weight loss, lethargy, nausea and vomiting
5
Q

what symptoms can be caused by a reginonal mets of a lung tumour?

A
  • hoarseness (L RLN palsy)
  • dyspnoea (anaemia, pleural or pericardial effusions)
  • dysphagia (oesophageal compression)
  • chest pain (parietal pleural involvement)
6
Q

which signs can be present in lung cancer?

A

Often no sign

  • cervical chain/supraclavicular lymphadenopathy
  • recurrent or slowly resolving pneumonia
  • signs of (unilateral) pleural effusion, e.g. decreased chest expansion, stony dullness, absent breath sounds
  • signs of lobar collapse, e.g. (ipsilateral) tracheal deviation, decreased airway entry
  • finger clubbing
  • asymmetric wheeze/stridor
  • Horner’s syndrome (Pancoast tumours)
  • SVC obstruction, e.g. facial swelling
7
Q

which neoplastic syndromes can be seen in lung cancer?

A
  1. PTHrP release - hypercalcaemia (squamous cell carcinoma)
  2. ADH release - SIADH and dilutional hyponatraemia (SCLC)
  3. ACTH-like peptide release - Cushing’s syndrome (SCLC)
8
Q

which investigations might be performed on a pt with lung cancer?

A
  1. bloods: FBC (?anaemia), UandE (?hypercalcaemia, hyponatraemia), LFTs, INR
  2. imaging
    - CXR: may show coin lesion, hilar enlargement, consolidation, pleural effusion or bony secondaries
    - staging contrast CT: chest (TNM staging), abdo (liver and adrenal glands), brain
    - PET-CET scan: for all potentially curable pts before Tx
  3. Histology
    - US-guided neck FNA: for cytology if lymphadenoapthy
    - bronchochoscopy + biopsy if endobronchial or transbronchial lesion
    - surgical biopsy: when less invasive methods unsuccessful
    - thoracoscopy: if pleural effusions or peripheral lesions
  4. Other
    - genetic testing for ECFR-TK mutation (may have important implications in Tx choices for pts with NSCLC)
    - lung function tests: on all pts pre-surgery
9
Q

what is the major risk factor for malignant mesothelioma?

A

asbestos exposure (latent period of up to 50yrs)

10
Q

describe the possible presentation of malignant mesothelioma

A

Symptoms

  • dyspnoea (due to pleural effusion or circumferential pleural thickening)
  • chest pain (typically dull, diffuse, progressive; can occasionally be pleuritic)
  • weight loss, fatigue, fever…

Signs:

  • +/- palpable chest wall mass
  • +/- clubbing (usually caused by underlying asbestosis)
11
Q

which investigations would be required in a pt with malignant mesothelioma

A
  1. Imaging
    - CXR and CT scan: may show pleural effusion, lobulated or nodular pleural thickening, pleural mass and rib destruction, +/- features of asbestos exposure
    - MRI and PET scans: may be performed
  2. Histology
    - pleural fluid: straw-coloured or blood stained. cytological analysis occasionally leads to Dx but pleural biopsy usually required
    - pleural biopsy